Social-ecological factors shaping women’s postpartum permanent contraception decision-making: Qualitative insights from a multi-site study
Abstract
Background The clinician-patient relationship is known to impact contraceptive care utilization, but less studied is how factors external to the clinician-patient relationship, such as prior experiences seeking reproductive healthcare or family dynamics and social networks, matter to patients’ postpartum contraceptive decision-making. Objective Our objective was to examine factors external to current patient-provider relationships that contribute to women’s decision-making surrounding postpartum permanent contraception (PC). Design This was a qualitative study at four U.S. healthcare systems with 75 postpartum women who had a documented plan for PC. Methods We conducted semi-structured interviews between March 2022 and June 2023. We employed a modified grounded theory approach to codebook thematic analysis. Results Patients described experiences across four key domains: individual, family, social networking, and policy ecologies. Individual-level influences included prior experiences with clinicians, health concerns, miscarriage experiences, future life goals, and apprehension toward medical procedures. Family-level influences centered on maintaining family wellbeing and accommodating partner preferences. Social networks shaped decisions through information and experiences shared by relatives, friends, community members, and social media. Policy-level influences included concerns regarding abortion access and parental leave policies. Conclusion Women’s decisions regarding postpartum permanent contraception are shaped by a complex interplay of personal experiences, family priorities, social networks, and policy contexts. Contraceptive counseling that acknowledges these influences may better support reproductive autonomy, address misinformation, and facilitate patient-centered decision-making.
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BibTeX
@article{rangaswamy2026socialecological,
title = {{Social-ecological factors shaping women’s postpartum permanent contraception decision-making: Qualitative insights from a multi-site study}},
author = {Dhweeja D. Rangaswamy MD and Kavita Shah Arora MD, MBE, MS and Brooke W. Bullington PhD and Kari White PhD and Suzanna Larkin MPH and Margaret Boozer MD and Tania Serna MD, MPH and Emily S. Miller MD, MPH and Jennifer L. Bailit MD, MPH and Kristen A. Berg PhD, CRC},
journal = {Women's Health},
year = {2026},
month = oct,
doi = {10.1177/17455057261500942},
url = {https://doi.org/10.1177/17455057261500942},
note = {CC BY},
}
RIS
TY - JOUR
TI - Social-ecological factors shaping women’s postpartum permanent contraception decision-making: Qualitative insights from a multi-site study
AU - Dhweeja D. Rangaswamy MD
AU - Kavita Shah Arora MD, MBE, MS
AU - Brooke W. Bullington PhD
AU - Kari White PhD
AU - Suzanna Larkin MPH
AU - Margaret Boozer MD
AU - Tania Serna MD, MPH
AU - Emily S. Miller MD, MPH
AU - Jennifer L. Bailit MD, MPH
AU - Kristen A. Berg PhD, CRC
PY - 2026
DA - 2026/10/29
JO - Women's Health
DO - 10.1177/17455057261500942
UR - https://doi.org/10.1177/17455057261500942
AB - Background The clinician-patient relationship is known to impact contraceptive care utilization, but less studied is how factors external to the clinician-patient relationship, such as prior experiences seeking reproductive healthcare or family dynamics and social networks, matter to patients’ postpartum contraceptive decision-making. Objective Our objective was to examine factors external to current patient-provider relationships that contribute to women’s decision-making surrounding postpartum permanent contraception (PC). Design This was a qualitative study at four U.S. healthcare systems with 75 postpartum women who had a documented plan for PC. Methods We conducted semi-structured interviews between March 2022 and June 2023. We employed a modified grounded theory approach to codebook thematic analysis. Results Patients described experiences across four key domains: individual, family, social networking, and policy ecologies. Individual-level influences included prior experiences with clinicians, health concerns, miscarriage experiences, future life goals, and apprehension toward medical procedures. Family-level influences centered on maintaining family wellbeing and accommodating partner preferences. Social networks shaped decisions through information and experiences shared by relatives, friends, community members, and social media. Policy-level influences included concerns regarding abortion access and parental leave policies. Conclusion Women’s decisions regarding postpartum permanent contraception are shaped by a complex interplay of personal experiences, family priorities, social networks, and policy contexts. Contraceptive counseling that acknowledges these influences may better support reproductive autonomy, address misinformation, and facilitate patient-centered decision-making.
SN - 1745-5065
ER -